Canadian Guidelines Support No Routine Mammograms Until 50

In November 2009 The United States Preventive Services Taskforce, an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services, changed the recommendations for women receiving screening mammograms.  They advised women to start at age 50 (not 40) and to undergo mammography every 2 years (not annually).  Dr. Diana Petitti, vice chairwoman of the task force and a professor of Biomedical Informatics at Arizona State University, said the guidelines were based on new data and analysis and were aimed at reducing the potential harm from overscreening. She was quoted in a N.Y. Times article “While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.”

The Canadian Task Force on Preventive Health Care in November 2011 issued new recommendations on breast cancer screening, and they are similar to the controversial guidelines issued in 2009 by the U.S. Preventive Services Task Force (USPSTF). Both task forces recommended women ages 40 to 49 who are at average risk for breast cancer not get routine mammograms. The Canadian guidelines also recommend a longer screening mammogram interval of once every 2 or 3 years (The USPSTF guidelines recommend every 2 years for women aged 50 to 74). What the task force concluded looking at the evidence was more frequent screening didn’t have an impact on the outcome and breast cancer death rates. There was also concern with the risk for false-positive tests and then unnecessary work and over-treatment. I agree with these recommendations.

One third of all breast cancers occur in women below the age of 45.  In this pre-menopausal age group mammography is less accurate in picking up cancers because pre-menopausal women have denser breast tissue than post-menopausal women. Dense breast tissue is not an issue with Thermography.  Thermography is an FDA adjunct to mammography and can be used safely at any age.

There are a growing number of physicians who are concerned about exposing pre-menopausal female breasts to radiation on an annual basis. Their breast tissue is especially sensitive to radiation. Contrary to conventional assurances that radiation exposure from mammography is trivial- and similar to that from a chest X-ray or spending a weekend at the beach, about 1/1,000 of a rad (radiation-absorbed dose) – the routine practice of taking four films for each breast results in some 1,000-fold greater exposure, 1 rad, focused on each breast rather than the entire chest. Thus, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads for each breast. A Johns Hopkins study published in 2009 in the Journal of the National Cancer Institute warned radiation exposure from annual mammograms could trigger breast malignancies in women with a strong family history of breast and/or ovarian cancers who have altered genes (identified as BRCA1 or BRCA2). And contrary to popular belief and assurances by the National Cancer Institute (NCI) and American Cancer Society (ACS), mammography is not a technique for early diagnosis. Unfortunately, a breast cancer has usually been present for about eight years before it can finally be detected.

An FDA approved adjunct (not replacement for) to mammography is Digital Infrared Thermal Imaging, better known as Thermography. Thermography is not an x-ray and there is no touching or compression of the body. Thermography is a test of physiology that uses a very sensitive medical digital infrared-sensing camera that develops a color image on a computer of a body’s thermal patterns. The underlying principle by which Thermography detects pre-cancerous or cancerous growths is because tumors have an increased blood flow and increased number of blood vessels to maintain their increased cellular growth. This causes an increase in temperature that is seen on the thermographic scan. Thermography is the only modality that can demonstrate whether a condition called estrogen dominance is affecting the breasts. Estrogen dominance is a potential risk factor for the development of breast cancer, fibrocystic breasts, uterine fibroids and ovarian cysts. Mammography does not demonstrate this hormonal imbalance.

Many women at risk for breast cancer in this country are under insured or do not have any health insurance at all. Gainesville Thermography has been approved by the United Breast Cancer Foundation to provide screening to eligible women.  This foundation provides grant monies to cover the costs of a breast screening and any necessary follow-up work for women who otherwise would not be screened. The program will resume in the Fall of 2010. Please contact the United Breast Cancer Foundation at 1-877-UBC-4CURE for further information.

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